15例混合型肝癌的临床病理分析  

Clinicopathological analysis for 15 cases of combined hepatocellular and cholangiocarcinoma

作　　者：左怀全[1] 叶念[1] 付华[1] 严律南[2] 曾勇[2] 吴泓[2] 周立新[2] 

机构地区：[1]泸州医学院附属医院,四川泸州646000 [2]四川大学华西医院,四川成都610041

出　　处：《中国现代医学杂志》2010年第20期3153-3156,共4页China Journal of Modern Medicine

摘　　要：目的通过比较原发性肝癌3种亚型的外科诊治结果,探讨混合型肝癌的诊断及临床病理特征。方法从1996年1月～2007年12月,对该院手术治疗的15例混合型肝癌、132例肝细胞癌及44例胆管细胞癌的临床病理资料进行回顾性分析。3组患者的临床病理特征从血液学指标(肝炎病毒感染状态、肝功能及血AFP水平)、治疗方法(手术和辅助治疗)、病理学资料(合并肝硬化、血管侵犯和淋巴结转移)等方面进行分析比较。随访3组患者,计算其术后1-、3-和5-年生存时间。结果除2例术前获得诊断外,其余13例混合型肝癌为术后病理及免疫组织化学确诊。根治性切除8例,姑息性切除7例,与肝细胞癌及胆管细胞癌相似(P>0.05)。混合型肝癌的病理特征表现为:合并门静脉癌栓及淋巴结转移比肝细胞癌常见(P<0.05);与胆管细胞癌相似;乙肝及丙肝病毒感染状态、合并肝硬化、血AFP水平等方面与肝细胞癌相似(P>0.05);与胆管细胞癌不同。术后1、3和5年生存率比较混合型肝癌差于肝细胞癌及胆管细胞癌(P<0.05)。结论混合型肝癌的术前诊断率低,恶性程度高,进展快,术后生存率较其他两型为差。Objective Combined hepatocellular and cholangiocarcinoma （cHCC-CC） is a rare subtype of primary liver cancer, and clinicopathological features of cHCC-CC have seldom been reported in detail. The aim of this study was to explore the diagnosis and clinicopathological characteristics of cHCC-CC in comparison with hepatocellular carcinoma （HCC） and cholangiocarcinoma （CC）.MethodsThe clinical material of 15 cHCC-CC, 132 HCC and 44 CC patients from January 1996 to December 2007 in west china hospital Sichuan University underwent hepatic resection were analyzed retrospectively. Clinicopathological characteristics such as hepatitis B viral infection sta-tus, serum hepatitis C virus （HCV） antibody, serum alpha-fetoprotein （AFP） level, cirrhosis status, vascular invasion, lymph nodes metastasis, surgical procedure and adjuvant treatment were recorded and analyzed between cHCC-CC with HCC and CC. Follow up were performed in three subtypes patients, and 1, 3 and 5 years survival rates of these patients were calculated.ResultsTwo cases of cHCC-CC were correctly diagnosed by enhanced CT before opera-tion,the other 13 cases were diagnosed by histology and immunohistochemistry after operation. Radical （8/15） and conservative hepatectomy （7/15） in cHCC-CC were similar to those of HCC and CC tumors （P〈0.05）. Pathological characteristics of cHCC-CC showed significantly more vascular invasion and lymph nodes metastasis than the HCC （P〈0.05）, and similarity to the CC （P〈0.05）. With regard to hepatitis B viral infection status, serum HCV antibody, cirrhosis status and serum AFP level, cHCC-CC patients showed greater similarity with HCC patients （P〈0.05） and difference from CC patients （P〈0.05）. The cumulative survival rates of 1, 3 and 5 years in cHCC-CC patients showed more poorer than patients with HCC or CC （P〈0.05）.ConclusionThe patients with cHCC-CC were sel-dom diagnosed before operation. The progression of cHCC-CC was more advanced than HCC or CC. Patients with cHC

关 键 词：混合型肝癌 临床特征 病理 

分 类 号：R735.7[医药卫生—肿瘤]